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About First Applicant

About Applicant 1 (About You)

What is your name?

Title

First name

Surname

What is your name

Why do we need to know this?

To ensure your quotation is valid for you and to save you time should you wish to apply.

Date of birth

Date of birth

Why do we need to know this?

Because the quotation is calculated on your exact date of birth, not just age.

Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don’t, your policy may be cancelled, or treated as if it never existed, or your claim rejected or not fully paid.

Sex

Have you smoked or used any form of tobacco or nicotine replacement products in the last 12 months?

Have you smoked in the last 12 months?

Why do we need to know this?

Because premiums are based on your smoking status. A smoker is someone who in the last 12 months uses cigarettes, cigars, pipe tobacco, chewing tobacco, any nicotine replacement products (for example chewing gums or patches), shisha pipes or electronic cigarettes.

Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don’t, your policy may be cancelled, or treated as if it never existed, or your claim rejected or not fully paid.

About Applicant 2

What is your name

To ensure your quotation is valid for you and to save you time should you wish to apply.

Date of birth

What is your date of birth ?

Why do we need to know this?

Because the quotation is calculated on your exact date of birth, not just age.

Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don’t, your policy may be cancelled, or treated as if it never existed, or your claim rejected or not fully paid.

Sex

Have you smoked or used any form of tobacco or nicotine replacement products in the last 12 months?

Have you smoked in the last 12 months?

Why do we need to know this?

Because premiums are based on your smoking status. A smoker is someone who in the last 12 months uses cigarettes, cigars, pipe tobacco, chewing tobacco, any nicotine replacement products (for example chewing gums or patches), shisha pipes or electronic cigarettes.

Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don’t, your policy may be cancelled, or treated as if it never existed, or your claim rejected or not fully paid.

Policy details

Policy details

Policy type

Policy Type

Level term life insurance

If you die during the policy term your insurer will pay the full amount of cover

Level term life & critical illness insurance

If you die or are diagnosed with a specified critical illness during the term your insurer will pay the amount you are covered for.

Mortgage protection life insurance

The amount of cover reduces to cover the balance on a repayment mortgage.

If you die during the term your insurer will pay the calculated amount of cover at that time.

Mortgage protection life & critical illness

The amount of cover reduces to cover the balance on a repayment mortgage.

If you die or are diagnosed with a specified critical illness during the term your insurer will pay the amount you are covered for.

Amount of cover (£)

Sum assured?

What do I do?

Enter the amount of cover that you require in the event of a claim during the policy term.

Policy term

Policy term

What do I do?

Enter the number of years you would like the insurance to last for.

Additional details

Additional details

Please enter your contact details so we can e-mail your quotation to you and assist you with your application.

Contact number

Contact Number

We'd like your phone number so we can give you a call about your quote. We won’t pressure you into buying anything and you won’t be contacted for any other reason.